A Few Bright Spots for Republicans. The Rest Can Be Scored as Grim.

In dry, stark language, the Congressional Budget Office on Monday punctured many of the stated goals for the Republican health care bill.

The budget analysis gave Republican senators just a few happy talking points. It found that average insurance premiums would be lower in 2020 than they are today. The bill would reduce the deficit by more than $300 billion over a decade. And it would produce a huge tax cut, albeit mostly for wealthier Americans.

But if you are a Republican senator looking for good news in this report, there were many more reasons to be glum than cheerful. And perhaps for that reason, the Senate Majority Leader Mitch McConnell of Kentucky announced on Tuesday that he would delay a vote on the bill.

The Better Care Reconciliation Act, as the Senate version of the bill is called, would mean 22 million fewer Americans would have insurance in a decade, the C.B.O. found, almost no change from the earlier House bill that the senators have been overhauling.

It said the legislation would increase deductibles, make insurance skimpier and destabilize markets. Average premiums would go down largely because the insurance they would pay for would become thinner and less valuable. Many older people, who are more likely to need insurance, would be priced out of the market.

President Trump asked the Senate to write a bill that was less “mean” than a version passed by the House last month. According to a White House news release, the budget office’s score is not disqualifying. But the fine print suggests the bill does not do much to help the people who would have been harmed under that earlier legislation. The Senate made major changes to the bill, but the budget office did not find that those changes would improve coverage much or increase the affordability of health care.

Although the Senate bill, unlike the House bill, would preserve rules prohibiting insurers from charging higher prices to customers with a history of illness, it would allow states to eliminate minimum standards for plan benefits and to permit annual and lifetime limits on coverage. Those changes mean that many Americans with serious illnesses would end up paying much more out of their own pockets for health care, even if they could buy coverage.

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Senator Rand Paul, Republican of Kentucky, who opposes the Senate health bill, commenting on the C.B.O. score Monday.CreditStephen Crowley/The New York Times

The budget office says that “most people” buying insurance in the new market would end up paying more for their care. For people with serious illnesses living in states with waivers, “some enrollees could see large increases in out-of-pocket spending.”

The Senate bill replaced flat, age-based premium subsidies with subsidies based on a sliding scale, according to income. That means that some people who would have been priced out of the insurance market under the House bill — particularly poorer, older Americans, in states with expensive health care systems — would get more help buying insurance under this plan.

But the budget office didn’t think that many such people would use those comparatively more generous tax credits, because of the high deductibles. Low-income people, it said, would look at both the sticker price and the value of health insurance and tend to opt out of the market.

“As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan,” the analysts said. The bill also took away financial assistance for higher-earning middle-income Americans. That change would leave an average 64-year-old earning around $55,000 with no help paying a $20,500 annual premium.

The Senate bill slowed a retreat from Medicaid expansion that was part of the Affordable Care Act. Instead of instantly slashing federal funding for that new population in 31 states in 2020, the Senate bill would step down the federal share of spending over several years. But according to the budget office, the end result is quite similar.

By the end of a decade, the budget office estimates that 15 million fewer Americans would have Medicaid coverage; that’s 1 million more than under the House bill. The Senate bill pays for the more generous Medicaid phaseout in the early years by reducing the program’s overall spending more sharply later. The budget office’s estimates span only 10 years, but its analysts noted that they expect “that after 2026, enrollment in Medicaid would continue to fall relative to what would happen under current law.”

The president has decried unstable markets under Obamacare, pointing to places that have been left with only one insurance carrier — or are at risk of none. The budget office said that the individual markets under the Senate bill would be less likely to be stable and more likely to include coverage gaps, particularly in rural areas.

“Some sparsely populated areas might have no nongroup insurance offered because the reductions in subsidies would lead fewer people to decide to purchase insurance — and markets with few purchasers are less profitable for insurers.” In other places, it notes, insurance would be available only with “very high premiums.”

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The Democratic senators, from left, Chuck Schumer, Patty Murray and Ron Wyden criticized the G.O.P. plan on Monday.CreditStephen Crowley/The New York Times

The 49-page assessment is full of other unfriendly news. It essentially suggests that one provision, to eliminate an Obamacare insurance regulation, would foster profiteering by insurance companies, by encouraging them to overcharge the government for certain plans.

It says that a provision locking out Americans from getting coverage for at least six months if they let their insurance lapse for 63 days or more — added on Monday to help stabilize insurance markets — would have almost zero effect.

Contrary to statements by Kellyanne Conway and other Trump advisers that the bill contains no overall cuts to Medicaid, the budget office offered a chart highlighting the spending reductions for the program. It says explicitly that “states would not have substantial additional flexibility” under the bill’s Medicaid reforms, a typical selling point for a plan that would push more fiscal risk to state governments. It says that a waiver program for state insurance regulations would increase the deficit and would not reduce the uninsured rate in every state. In addition, the analysts wrote, “waivers would probably cause market instability in some areas.”

Several senators have expressed concern about the bill’s effects on residents affected by the opioid epidemic. The budget analysis noted that mental health services “could be at risk,” as states pare back their required benefits under the waivers.

Budget analysts estimated that about 15 percent of women in some areas would lose health care access because of provisions to defund Planned Parenthood, and would not find an alternative source of care. That estimate may worry two senators, Susan Collins and Lisa Murkowski, who have expressed concerns about the bill’s effects on women’s health. The Planned Parenthood cuts would also result in several thousand “additional births,” increasing Medicaid spending on maternity and pediatric care, the report said.

Analysts noted that the biggest tax cuts in the bill “are not directly related to health insurance coverage.”

The report also offers some unpleasant news about the next political window: While the longer-term premium and savings numbers may comport with Republicans’ policy preferences, the short-term numbers are less desirable. Despite substantial extra spending, meant to stabilize insurance markets, the budget office estimates that premiums would go up by 20 percent next year, and 15 million fewer Americans would have health coverage, in a year when voters are casting ballots in congressional races. (The deficit would increase in that period, too, according to the estimate.)

So far, Mitch McConnell, the Senate majority leader, has responded by applauding the deficit and premium numbers. And the White House has responded by assailing the credibility of the nonpartisan budget office. But the rewrite of the House bill has not led the budget office to revise its overall assessment of the effort: More than 20 million Americans would lose coverage, and many of those retaining it would end up with insurance that costs them more and covers less.

A version of this article appears in print on , Section A, Page 18 of the New York edition with the headline: Few Bright Spots in C.B.O.’s Analysis of Health Bill. Order Reprints | Today’s Paper | Subscribe